Your Skin and Multiple Myeloma

Multiple myeloma isn't typically associated with skin concerns or lesions, but some myeloma patients have been diagnosed with multiple myeloma after a skin issue and these cases should not be overlooked. Every patient matters. 

Types of Skin Involvement in Multiple Myeloma

The first group of skin concerns is directly related to multiple myeloma. As we know, multiple myeloma produces an excessive amount of plasma cells. These plasma cells can produce skin manifestations when they colonize the patients’ dermis (the inner layer of the skin). This is called a cutaneous plasmacytoma (which is very rare).

The second group of skin issues represents skin lesions or disorders that are associated with an increased M protein and/or increased levels of monoclonal immunoglobulins, which are key components of multiple myeloma. 

A third group of skin issues are reactions to myeloma therapies such as bortezomib and lenalidomide. Some of the skin events reported as side effects of these drugs are rash, mucositis, and edema. (You can learn more about common side effects of myeloma treatment through the HealthTree Cure Hub under Patient Solutions. You can also learn more about other myeloma patients’ journeys with side effects by joining our Community Forums.

Skin Manifestations of Multiple Myeloma

Since skin involvement is a rare finding in multiple myeloma, there will be few patients who show skin lesions or disease as the initial presentation of myeloma. That poses a diagnostic challenge for the treating physician because multiple myeloma is not the first diagnosis that comes to mind when the main reason for the medical visit is a skin complaint. 

Nevertheless, some of the features that these patients present, and could therefore lead to the diagnosis of multiple myeloma are: 

• Unusual presentation of the skin lesion
• Skin problems that do not respond to conventional therapy 
• Abnormal blood test results

Multiple Myeloma and Melanoma

As we are reminded in the article I don’t Have Melanoma, I have Multiple Myeloma people tend to confuse “Multiple Myeloma” with “Melanoma”. They are completely separate cancers: multiple myeloma is a cancer of plasma cells, while melanoma is a cancer of melanocytes (which are the cells that produce the pigment of our skin).

The HealthTree Foundation focuses on Multiple Myeloma NOT Melanoma, however, some studies have investigated the relationship between multiple myeloma and the incidence of skin cancer. 

In the article “Secondary malignancies in patients with multiple myeloma, Waldenstrom macroglobulinemia and monoclonal gammopathy of undetermined significance”  results support conflicting but generally supportive information about an increased risk of secondary cancers (skin cancer included) in patients with Multiple Myeloma.

• One of the studies found an increased risk of developing melanoma in patients with multiple myeloma, however, other studies did not find this association 
• In another study, the presence of other skin cancers was increased, while the risk of melanoma did not seem to increase 
• Another study reported an increased risk of melanoma in patients with Waldenstrom Macroglobulinemia 
• Other studies do not report a significant increase in skin cancer 
• Another study reported an increased presence of squamous cell carcinoma in patients with multiple myeloma as compared to the control group 
• There has also been an association between lenalidomide (Revlimid), and an increase in non-melanoma skin cancers, as reported by Dr. John R Jones in the article “Safety of lenalidomide for maintenance treatment of patients with multiple myeloma following autologous stem cell transplantation.”

The bottom line is that multiple myeloma and myeloma treatment can increase the risk of some infections and additional primary malignancies. Some studies have investigated the relationship between multiple myeloma and the risk of skin cancer. While further research needs to be done regarding these associations, prevention is key.

Real World Evidence in HealthTree Cure Hub

For patients using the Real World Evidence portal called the HealthTree Cure Hub, 699 myeloma patients reported having a secondary cancer, melanoma being 15% of the secondary cancers. To put this into perspective, the incidence rate of melanoma of the skin in the US standard population is .02%, as reported by the American Cancer Society.

(You can share your secondary cancer experience by creating a HealthTree Cure Hub profile here, then click on Full Health Profile)

Prevention is Key: Skin Care is Skin Health

Skin cancer prevention is a top public health priority for the American Academy of Dermatology Association. 

One of the major risk factors for skin cancer is unprotected exposure to the sun’s UV rays. Therefore, prevention starts by tackling this key risk factor.

You can take action for prevention by doing the following:

• Wear sunscreen! Even better: wear water-resistant sunscreen with an SPF of 30 or higher to uncovered skin.
• Reapply sunscreen every two hours when outdoors! Yes, you read correctly. Applying sunscreen once a day is simply not enough.
• Follow the American Academy of Dermatology comprehensive sun protection plan: seek shade; wear protective clothing, including a lightweight, long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses. 
• Stay vigilant! HealthTree is all about empowering patients. Know your skin, ask questions, stay informed. Notice a suspicious skin mole or lesion? Schedule a consult. 
• Finally, attend your Dermatology check-up. Your Dermatologist is your skin’s best friend. Let the experts take care of you.

List of References

¹ Harati A, Brockmeyer NH, Altmeyer P, Kreuter A. Skin disorders in association with monoclonal gammopathies. Eur J Med Res. 2005 Mar 29;10(3):93-104. PMID: 15851375.

² Ibid.

³ Patrizi A, Venturi M, Dika E, Maibach H, Tacchetti P, Brandi G. Cutaneous adverse reactions linked to targeted anticancer therapies bortezomib and lenalidomide for multiple myeloma: new drugs, old side effects. Cutan Ocul Toxicol. 2014 Mar;33(1):1-6. doi: 10.3109/15569527.2013.787086. Epub 2013 May 2. PMID: 23638756.

⁴ Behera B, Pattnaik M, Sahu B, Mohanty P, Jena S, Mohapatra L. Cutaneous Manifestations of Multiple Myeloma. Indian J Dermatol. 2016 Nov-Dec;61(6):668-671. doi: 10.4103/0019-5154.193682. PMID: 27904188; PMCID: PMC5122285.

⁵ Behera B, Pattnaik M, Sahu B, Mohanty P, Jena S, Mohapatra L. Cutaneous Manifestations of Multiple Myeloma. Indian J Dermatol. 2016 Nov-Dec;61(6):668-671. doi: 10.4103/0019-5154.193682. PMID: 27904188; PMCID: PMC5122285.

⁶ Idem.

⁷ Idem.

⁸ Idem.

⁹ Castillo JJ, Gertz MA. Secondary malignancies in patients with multiple myeloma, Waldenström macroglobulinemia and monoclonal gammopathy of undetermined significance. Leuk Lymphoma. 2017 Apr;58(4):773-780. doi: 10.1080/10428194.2016.1217527. Epub 2016 Aug 22. PMID: 27546465.

¹0 Razavi P, Rand KA, Cozen W, et al. Patterns of second primary malignancy risk in multiple myeloma patients before and after the introduction of novel therapeutics. Blood Cancer J. 2013;3:e121.

¹1 Mailankody S, Pfeiffer RM, Kristinsson SY, et al. Risk of acute myeloid leukemia and myelodysplastic syndromes after multiple myeloma and its precursor disease (MGUS). Blood. 2011;118:4086–4092.

¹2 Castillo JJ, Gertz MA. Secondary malignancies in patients with multiple myeloma, Waldenström macroglobulinemia and monoclonal gammopathy of undetermined significance. Leuk Lymphoma. 2017 Apr;58(4):773-780. doi: 10.1080/10428194.2016.1217527. Epub 2016 Aug 22. PMID: 27546465.

¹3 Ibid.

¹4 Ibid.

¹5 Robinson AA, Wang J, Vardanyan S, Madden EK, Hebroni F, Udd KA, Spektor TM, Nosrati JD, Kitto AZ, Zahab M, Cheema S, Fors DH, Norberg A, Diehl J, Waterman GN, Swift RA, Crowley J, Berenson JR. Risk of skin cancer in multiple myeloma patients: a retrospective cohort study. Eur J Haematol. 2016 Nov;97(5):439-444. doi: 10.1111/ejh.12748. Epub 2016 Mar 7. PMID: 26872804.

¹6 Yang J, Terebelo HR, Zonder JA. Secondary primary malignancies in multiple myeloma: an old NEMESIS revisited. Adv Hematol. 2012;2012:801495. Epub 2012 Jul 19.

¹7 https://www.aad.org/news/aad-survey-shows-americans-need-sunscreen-education

¹8 Idem.

¹9 https://www.aad.org/news/proposed-fda-sunscreen-administrative-order

10 https://cancerstatisticscenter.cancer.org/#!/cancer-site/Melanoma%20of%20the%20skin

11 https://pubmed.ncbi.nlm.nih.gov/34184970/